1/20. The pathology of human west nile virus infection.west nile virus (WNV) was identified by immunohistochemistry (IHC) and polymerase chain reaction (PCR) as the etiologic agent in 4 encephalitis fatalities in new york city in the late summer of 1999. The fatalities occurred in persons with a mean age of 81.5 years, each of whom had underlying medical problems. Cardinal clinical manifestations included fever and profound muscle weakness. autopsy disclosed encephalitis in 2 instances and meningoencephalitis in the remaining 2. The inflammation was mostly mononuclear and formed microglial nodules and perivascular clusters in the white and gray matter. The brainstem, particularly the medulla, was involved most extensively. In 2 brains, cranial nerve roots had endoneural mononuclear inflammation. In addition, 1 person had acute pancreatitis. Based on our experience, we offer recommendations for the autopsy evaluation of suspected WNV fatalities.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/20. West Nile encephalitis: the neuropathology of four fatalities.west nile virus was identified by immunohistochemistry (IHC) and polymerase chain reaction (PCR) as the etiologic agent in four encephalitis fatalities in new york city in the late summer of 1999. fever and profound muscle weakness were the predominant symptoms. autopsy disclosed encephalitis in two instances and meningoencephalitis in the remaining two. The inflammation was mostly mononuclear and formed microglial nodules and perivascular clusters in the white and gray matter. The brain stem, particularly the medulla, was involved most extensively. In two brains, cranial nerve roots had endoneural mononuclear inflammtion. In addition, one person had acute pancreatitis. On the basis of our experience, we offer recommendations for the autopsy evaluation of suspected WNV fatalities.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
3/20. Update: Investigations of west nile virus infections in recipients of organ transplantation and blood transfusion.An investigation involving CDC, the food and Drug Administration (FDA), the health resources and Services Administration (HRSA), the georgia Division of public health, and the florida Department of Health identified west nile virus (WNV)-associated illnesses in four recipients of organs from the same donor. Although the transplanted organs were the source of infection for the four organ recipients, the source of the organ donor's infection remains unknown; an investigation of the numerous transfusions received by the organ donor is ongoing.- - - - - - - - - - ranking = 204.44508100107keywords = organ (Clic here for more details about this article) |
4/20. Update: Investigations of west nile virus infections in recipients of organ transplantation and blood transfusion--michigan, 2002.On September 27, 2002, this report was posted on the MMWR website (http://www.cdc.gov/mmwr). CDC, the food and Drug Administration (FDA), the health resources and Services Administration (HRSA), and state and local health departments continue to investigate west nile virus (WNV) infections in recipients of organ transplantation and blood transfusion. This report summarizes two investigations of michigan recipients of blood products, one of whom also received a liver transplant. Both persons tested positive for WNV infection after receiving blood products derived from a single blood donation subsequently found to have evidence of WNV. These investigations provide further evidence that WNV is transmitted through blood transfusion.- - - - - - - - - - ranking = 113.58060055615keywords = organ (Clic here for more details about this article) |
5/20. Transmission of west nile virus from an organ donor to four transplant recipients.BACKGROUND: In August 2002, fever and mental-status changes developed in recipients of organs from a common donor. Transmission of west nile virus through organ transplantation was suspected. methods: We reviewed medical records, conducted interviews, and collected blood and tissue samples for testing with a variety of assays. persons who donated blood to the organ donor and associated blood components were identified and tested for west nile virus. RESULTS: We identified west nile virus infection in the organ donor and in all four organ recipients. Encephalitis developed in three of the organ recipients, and febrile illness developed in one. Three recipients became seropositive for west nile virus IgM antibody; the fourth recipient had brain tissue that was positive for west nile virus by isolation and nucleic acid and antigen assays. serum specimens obtained from the organ donor before and immediately after blood transfusions showed no evidence of west nile virus; however, serum and plasma samples obtained at the time of organ recovery were positive on viral nucleic acid testing and viral culture. The organ donor had received blood transfusions from 63 donors. A review of blood donors and follow-up testing identified one donor who had viremia at the time of donation and who became seropositive for west nile virus IgM antibodies during the next two months. CONCLUSIONS: Our investigation of this cluster documents the transmission of west nile virus by organ transplantation. Organ recipients receiving immunosuppressive drugs may be at high risk for severe disease after west nile virus infection. blood transfusion was the probable source of the west nile virus viremia in the organ donor.- - - - - - - - - - ranking = 340.74180166845keywords = organ (Clic here for more details about this article) |
6/20. Asymmetric flaccid paralysis: a neuromuscular presentation of west nile virus infection.The neuromuscular aspects of west nile virus (WNV) infection have not been characterized in detail. We have studied a group of six patients with proven WNV infection. All cases presented with acute, severe, asymmetric, or monolimb weakness, with minimal or no sensory disturbance after a mild flu-like prodrome. Four cases also had facial weakness. Three of our cases had no encephalitic signs or symptoms despite cerebrospinal fluid pleocytosis. Electrophysiological studies showed severe denervation in paralyzed limb muscles, suggesting either motor neuron or multiple ventral nerve root damage. This localization is supported further by the finding of abnormal signal intensity confined to the anterior horns on a lumbar spine magnetic resonance imaging. Muscle biopsies from three patients showed scattered necrotic fibers, implicating mild direct or indirect muscle damage from the WNV infection. In summary, we describe a group of patients with acute segmental flaccid paralysis with minimal or no encephalitic or sensory signs. We have localized the abnormality to either the spinal motor neurons or their ventral nerve roots. It will be important for physicians to consider WNV infection in patients with acute asymmetric paralysis with or without encephalitic symptoms.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
7/20. West Nile encephalitis in 2 hematopoietic stem cell transplant recipients: case series and literature review.Most human cases of west nile virus infection are acquired via bites from an infected mosquito. In some cases, infection may also be transmitted by infected blood products or transplanted organs. There have been recent publications suggesting that chemotherapy and immunosuppression may increase a person's risks of developing central nervous system disease if the person is infected with the west nile virus. Because patients undergoing hematopoietic stem cell transplantation not only are immunocompromised, but also receive multiple blood products, they are at a particularly high risk for acquiring symptomatic disease if exposed to the west nile virus. We describe here 2 patients who underwent hematopoietic transplantation at our institution and subsequently developed fatal west nile virus infections.- - - - - - - - - - ranking = 22.71612011123keywords = organ (Clic here for more details about this article) |
8/20. Fatal west nile virus encephalitis in a renal transplant recipient.west nile virus (WNV), a mosquito-transmitted single-stranded rna flavivirus, causes human disease of variable severity. We report clinical and pathologic findings of fatal encephalitis from the transmission of WNV from an organ donor to a kidney transplant recipient. The patient developed a febrile illness 18 days after transplantation, which progressed to encephalitis. Postmortem examination demonstrated extensive viral encephalopathic changes. Immunohistochemical studies highlighted WNV antigens within neurons, especially in the cerebellum and brainstem. flavivirus virions were detected ultrastructurally within the cerebellum, and WNV was isolated from the brain and the brainstem. Thus, this case demonstrates the first death in the first solid organ transplant-associated transmission of WNV. immunosuppression of the transplant recipient might have been responsible for the fulminant viral effects. The pathologic diagnosis helped guide subsequent epidemiologic and laboratory studies.- - - - - - - - - - ranking = 45.43224022246keywords = organ (Clic here for more details about this article) |
9/20. Community-acquired west nile virus infection in solid-organ transplant recipients.BACKGROUND: west nile virus (WNV) is rapidly spreading through north america. In the general population, the majority of WNV infections are asymptomatic. During 2002, an outbreak of WNV occurred in Toronto, canada. We observed four cases of severe symptomatic community-acquired WNV infection in our organ-transplant population. methods: Patient data were obtained from chart review. WNV was diagnosed by acute and convalescent serology. incidence was compared with data obtained from a population-based surveillance program. RESULTS: Four transplant patients had WNV encephalitis (n=3) or meningitis (n=1). Mean age was 44.5 (range 26-58) years and transplant type included kidney (n=2), liver (n=1), and heart (n=1). The mean time posttransplant was 3.8 years (range 2 months-8 years). The presenting symptoms were fever (4/4), confusion (3/4), headache (4/4), and weakness (2/4). cerebrospinal fluid showed a pleocytosis in all patients and elevated protein in three of four. All patients had identifiable occupational or recreational risk factors. There was no evidence that the infection was acquired by transfusion or the transplanted organ. Outcomes were full recovery (2/4), lower limb paralysis (1/4), and death (1/4). On the basis of active population surveillance data, the rate of WNV meningoencephalitis in the general population in the Toronto area was approximately 5 per 100,000. This compares to four cases in a transplant population of 2,000 patients (rate 200 per 100,000) (P<0.001). CONCLUSIONS: Transplant patients are likely at greater risk of severe neurologic disease caused by community-acquired WNV compared with the general population. Prevention of transmission and patient education may be more important in this population.- - - - - - - - - - ranking = 136.29672066738keywords = organ (Clic here for more details about this article) |
10/20. west nile virus encephalitis in organ transplant recipients: another high-risk group for meningoencephalitis and death.west nile virus infection has been spreading westward across the continental united states since 1999. Although it often presents as a mild, self-limiting viral illness, it can result in a devastating meningoencephalitis in some patient populations, particularly the elderly. We report in this article on two immunosuppressed transplant patients who developed a severe meningoencephalitis caused by mosquito-borne west nile virus infection. Suggestions for the prevention, diagnosis, and treatment of west nile virus infection in this patient population are described.- - - - - - - - - - ranking = 90.86448044492keywords = organ (Clic here for more details about this article) |
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